20040807.pdfDATE RECEIVED
CITY OF EDMONDS 77-
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER
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PLAT NAMEISUBDIVISION NO. LOTNO. LID NO.
LID FEE $
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RW Permit Required
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E S Street Use Permit Roq'd 13
XISTING � PROPOSED Inspectjon Required 13
Sidewalk Required E3
REQUIRED DEDICATION- FT Underground
_]�� Wiring required 13
METER SIZE LINE SIZ XTURES PRV REQUIRED
I YES 11 NO
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EMARKS
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OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ADDITION
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MULTIFAMILY
REPAIR
GRADING cyos
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKFRY
(TYPE OF USE, BOINESS OR ACTIVITY) EXPLAIN
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
NUMBER NUMBER OF CRITICAL
OF DWELLING AR
STORIES UEAS
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UNITS N BER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING
PLAN CHEkCK NO: ___TVESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARO
:i UEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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W PERMIT APPLICATION: 180DAyS
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THe'ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
DAT7, SIGNE
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ALLOWED PROPOSED
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LOT COVERAGE
ALLOWED
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REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
PROPOSED
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I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
L;HECKED PY I TYPE OF CONSTRUCTION CODE OCCUPANT
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SPECIAL INSPECTION JAREA OCCUPANT
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRCID9 FINAL INSPECTION REO'D z
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VALUATION
$ ;j I,!,
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge 4 11,6?"
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt, Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
:FICIALS SIGNATURE ATE
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ATTENTION /'�'T-_
Off 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- 19
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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/DATE
ORIGINAL FILE YELLOW-INSPECrC
PINK-OWNEA GOLD-ASSESSOIR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR 05
OCCUPANCY ..................
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